The theme for this year’s World Hepatitis Day is “We are not waiting”. This is a theme chosen by the community of people affected by viral hepatitis, predominantly hepatitis B, C and D, all of them chronic diseases that lead too often to cirrhosis and liver cancer. Depending how you read it, it is not an encouraging message. It is saying that the community cannot wait any longer for policymakers to take action. The community will do what it can, raising awareness, promoting testing, supporting people burdened with these diseases and continuing to advocate for change – while policymakers continue to dither. But it will not be enough.

With some notable and laudable exceptions, most countries have done little since I first wrote to every Ministry of Health in 2008 begging them to take action and make World Hepatitis Day an official WHO day. The world has committed to elimination of viral hepatitis by 2030, successive strategies have been agreed in order to get there, the latest in 2022, yet so little is really done.

2030 is tomorrow. Prevention, testing and treatment programmes need to be established but they will not yield results overnight. They need to be put in place now. They cannot wait. Nor can the 300 million people living with chronic viral hepatitis who remain unaware that they are living with a life-threatening disease that could be either cured or managed if only they were diagnosed. Nor can the expectant mothers who should be screened. Nor can their new-borns who need to be vaccinated at birth.

Back in 2008, more than 1 million people were dying from viral hepatitis every year. Still today more than a million people are dying from viral hepatitis every year. What is particularly tragic about this is that most of the deaths are eminently preventable. We have the tools and they are extraordinarily cost-effective, some of them actually cost saving over a very short time horizon. We are simply not using them.  For example, 80% of those living with viral hepatitis are undiagnosed; daclatasvir, one of the treatments for hepatitis C for which MPP has a licence, has been commercialised in 37 countries but we have a licence that covers 112 countries; only 1.4 million daclatasvir or daclatasvir treatments have been sold but 50 million people need to be treated; Out of 54 countries in Africa 36 do not give routine hepatitis B birth dose vaccination.

There is no question that the fiscal space within country budgets has shrunk, squeezed by the pandemic, by war and by energy prices. This means that efficiency is key to making expenditure on viral hepatitis possible. The interventions for viral hepatitis need to be integrated into other health programmes to maximise the efficiency gains. Even Egypt, with its huge burden of hepatitis C and pressing need to address it, combined its population-wide hepatitis C testing programme with testing for other prevalent diseases. For each country how to combine viral hepatitis interventions with those for other diseases will depend on its particular epidemiological situation. But that must be the way forward.

This failure to make use of the eminently affordable interventions available raises another critical issue. The global health community has invested significant effort and resources to make interventions affordable in low- and middle-income countries (LMICs) but, if there is no uptake, then why will the global health community continue to make them available at affordable prices? In our particular case, pharmaceutical companies are already asking why they should give MPP licences to make medicines available and affordable for LMICs, if governments do not use the opportunity to buy the medicines and treat people. From the other side, generic companies are asking why they should invest in developing generic versions if there is no market because governments are not buying the medicines. This is a very real threat and viral hepatitis is a stand-out example of too little impact.

As we approach another World Hepatitis Day, the time for nice words at the World Health Assembly is past. Now we need action.

But I would like to end on a positive note. I was delighted when just last month Gavi’s Board decided to continue to implement Gavi’s Vaccine Investment Strategy, and re-start programmes to introduce vaccines that were previously approved but paused either due to the pandemic or product development delays. On this list is the hepatitis B birth dose, among others.  Gavi will work with Vaccine Alliance partners, particularly WHO, UNICEF and countries to create timelines, technical guidance for introduction of products, and outline the parameters of these new programmes. This is tremendous news for newborns who really cannot wait.

Charles Gore

Executive Director